Bowel Endometriosis Excision: Approaches and Outcomes Including Hand Sewing of Discoid Excision

Louisa R Chatroux; Parmida Maghsoudlou; Mobolaji O Ajao; Louise P King; Jon I Einarsson

doi:10.1016/j.jmig.2024.07.019

Bowel Endometriosis Excision: Approaches and Outcomes Including Hand Sewing of Discoid Excision

J Minim Invasive Gynecol. 2024 Jul 31:S1553-4650(24)00323-6. doi: 10.1016/j.jmig.2024.07.019. Online ahead of print.

Authors

Louisa R Chatroux¹, Parmida Maghsoudlou², Mobolaji O Ajao², Louise P King², Jon I Einarsson²

Affiliations

¹ Brigham & Women's Hospital, Department of Obstetrics, Gynecology and Reproductive Biology Division of Minimally Invasive Gynecologic Surgery, Harvard Medical School, Boston, Massachusetts (all authors). Electronic address: louisachatroux@gmail.com.
² Brigham & Women's Hospital, Department of Obstetrics, Gynecology and Reproductive Biology Division of Minimally Invasive Gynecologic Surgery, Harvard Medical School, Boston, Massachusetts (all authors).

PMID: 39089645
DOI: 10.1016/j.jmig.2024.07.019

Abstract

Study objective: To examine the outcomes of surgery performed for bowel endometriosis including shaving, discoid resections with hand-sewn closure, and segmental resection.

Design: Retrospective cohort study.

Setting: Large academic hospital.

Patients: All patients with bowel wall endometriosis who underwent surgical excision with the Division of Minimally Invasive Gynecologic Surgery between 2009 and 2022.

Interventions: No interventions administered.

Measurements and main results: From 2009 to 2022, a total of 112 patients underwent laparoscopic excision of endometriosis involving the rectum. From this cohort, 82 underwent shaving, 23 underwent discoid excision, and 7 had segmental bowel resection. The discoid excisions were closed in multiple layers with hand sewing and were not closed with a staple device. Average lesion size on preoperative imaging was 20.9 mm in the shave group, 22.5 mm in the discoid group, and 38.5 mm in the segmental group. Complication requiring reoperation for anastomotic leak occurred in 3 cases (3.66%) of the shave group and 1 case (4.35%) of the discoid excision group, but did not occur in any of the segmental resections. The number of layers of closure and type of suture used did not appear to have an effect on complication rate, however, this study was not powered to detect a meaningful difference.

Conclusion: Our data shows a similar rate of anastomotic leak complication for each closure type as that reported in the literature (2.2%, 9.7%, and 9.9% reported for shave, discoid and segmental resection, respectively). While our study is underpowered, these findings support that hand sewing for discoid excision is a safe and reasonable alternative to circular stapler closures and can be considered with an experienced surgeon. Further study is warranted to confirm safety and explore potential cost savings associated with this technique as well as applications in areas with less resources available.

Keywords: Bowel endometriosis; Discoid resection; Laparoscopic excision; Segmental resection; Surgical outcomes.